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LifeWise Health Plans
Effective starting 9/1/07 |
Plan
Summary (PDF)
Plan
Rates (PDF) |
Plan
Summary (PDF)
Plan
Rates (PDF) |
Plan
Summary (PDF)
Plan
Rates (PDF) |
| Features |
• Affordable basic coverage
• Lower monthly rates |
• Broadest
coverage
• Choice of deductible and copay options |
• Tax-advantaged savings plan
• Lower monthly rates |
| Individual Deductible |
$1,500 / $2,500 / $5,000 / $7,500 |
$500 / $1,000 /
$2,500 / $5,000 |
$3,000 individual
$6,000 family** |
Coinsurance
(what you pay) |
25% |
20% |
20% |
| Coinsurance Maximum |
$9,000 |
$7,500 |
$2,000 individual
$4,000 family |
Out-of-Pocket Maximum
|
Annual deductible +
coinsurance maximum |
Annual deductible +
coinsurance maximum |
Annual deductible +
coinsurance maximum |
Office Visits and
Preventive Exams |
No deductible applies on first six visits ($25 copay
only); subsequent visits subject to deductible and 25% |
$20 copay per visit |
Preventive Exams: No deductible applies, you pay 20%
Office Visits: Deductible
applies first, then you pay 20% |
Alternative Care
(12 shared visits per calendar year for spinal manipulations
and acupuncture) |
$25 copay |
$25 copay |
After paying deductible, you pay 20% |
Pharmacy
(Retail 30-day supply) |
$20 generic only |
$20 generic; 50%
brand |
After paying deductible, you pay 20%; preventive
generic cardiac drugs reimbursed at 100%* |
Pharmacy
(Mail Order 90-day supply) |
$50 generic only |
$50 generic; 45%
brand |
Not available |
| Maternity |
After paying deductible, you pay 25% |
After paying
deductible, you pay 20% |
After paying deductible, you pay 20% |
| Vision Care |
Not covered |
Exams covered in
full (one exam per two calendar years) $200 for frames, lenses and
contact lenses (per two calendar years) |
Not covered |